The purpose of this International Research Scientist Development Award is to provide Erica L. Dueger, DVM, PhD with a period of protected time for training and mentored research that will prepare her to pursue an independent career in international public health. Dr. Dueger is an assistant scientist at the Johns Hopkins Bloomberg School of Public Health (JHSPH) in the Department of International Health and is currently conducting field research on the epidemiology of Streptococcus pneumoniae at the Centro de Estudio y Control de Enfermedades (CECEN) at the Universidad del Valle de Guatemala. The candidate' s long-term goal is to contribute to the improvement of global health through research and policy development in infectious diseases and vaccinology. Following completion of this mentored research project and training period, Dr. Dueger will be positioned to compete successfully for NIH individual investigator funding and effectively and independently conduct collaborative, interdisciplinary research projects in disease surveillance and vaccinology worldwide. Through this grant, the candidate aims to develop a base of skills and knowledge that are critical to conducting large scale, community-based surveillance research and vaccine trials. Her goals are 1) to develop skills necessary to successfully transition from veterinary-focused research to international human public health research; 2) to obtain training in laboratory techniques, quality control assurance, Good Laboratory and Clinical Practices (GLP and GCP), and geographical information systems; 3) to develop grant writing skills; 4) to obtain fluency in Spanish; and 4) to gain practical experience in the conduct of population-based research in the developing world, particularly in the areas of infectious disease surveillance and vaccine trials. She plans to achieve these goals through a combination of coursework, intensive laboratory training, conferences and workshops, conversational Spanish classes, and a mentored research project. The primary objective for this application is to define the community prevalence of penicillin non-susceptible S. pneumoniae (PRSP) and to evaluate the impact of a protein-based vaccine on nasopharyngeal carriage of this organism. We will evaluate the feasibility of using lot quality assurance sampling (LQAS) methods to identify clusters of high PRSP prevalence and we will compare the prevalence and geographic distribution of PRSP in children < 2 years of age from different urban socio-economic strata with rural areas of Guatemala. This will be accomplished by a series of cross-sectional surveys of nasopharyngeal samples in target socio-economic groups using both stratified random sampling and LQAS. The proposed project will take advantage of the infrastructure created by a large ongoing outpatient surveillance study at CECEN evaluating the incidence of invasive pneumococcal disease in Guatemala City, as well as a CECEN Phase II clinical trial to evaluate a protein based S. pneumoniae vaccine in infants. In the latter part of the award, the proposal will test the feasibility of using LQAS sampling methodologies to determine prevalence of PRSP from selected urban zones and rural departments of Guatemala. The study will provide crucial information for the development of models for community transmission dynamics of drug-resistant S. pneumoniae in Guatemala. These models and study methods will be used to identify intervention points for at risk populations and to evaluate strategies, including vaccines, for the control of PRSP. As such, this proposal addresses an emerging and rapidly increasing public health problem in many developing countries, including Guatemala.